Ten novel trichothecene sesquiterpenoids including two new seco-trichothecenes, trichotheciumones A (1) and B (2), a new trichothecene sesquiterpenoid glycoside, trichothecinoside A (3), and seven new trichothecene sesquiterpenoids, trichothecrotocins T-Z (4-10), together with three new natural products (11-13) and thirteen known compounds (14-26), were isolated from the soil fungus Trichothecium sp. DWS815. The structures and absolute configurations of the new compounds were elucidated by extensive spectroscopic analyses and quantum chemistry ECD calculations. Given the notable anticancer properties of known trichothecenes, the isolated compounds were evaluated for the cytotoxic activities against three cancer cell lines (HCT116, 4T1, MHCC97H) and one normal cell line (GES-1). Cell cycle analysis revealed new compounds 7 and 8 induced G2/M phase arrest in HCT116 cancer cells, which resulted to cell proliferation inhibition activity.
To examine the association between the skeletal muscle mass-to-visceral fat area ratio (SVR) and prevalent cardiovascular disease (CVD) in a nationally representative U.S. We analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES), 2011-2018. Associations of SVR with composite CVD and its subtypes (heart failure [HF], coronary heart disease [CHD], angina pectoris [AP], myocardial infarction [MI], or stroke) were estimated using multivariable logistic models; linear trend across SVR tertiles was tested, and nonlinearity was assessed using restricted cubic spline (RCS) models. Subgroup analyses assessed heterogeneity. The sample comprised 9,997 participants. In multivariable-adjusted logistic models, higher SVR was associated with lower odds of CVD (Model 4: OR = 0.44; 95% CI 0.29-0.67; P < 0.001), with a dose-response (P for trend = 0.001). In subtype analyses, the highest SVR category was associated with lower odds of HF (OR = 0.42, 95% CI 0.18-0.96; P = 0.047), CHD (OR = 0.28, 95% CI 0.11-0.71; P = 0.011), and MI (OR = 0.33, 95% CI 0.11-0.94; P = 0.045), with significant trends for all three outcomes (P for trend < 0.05). RCS models showed nonlinear associations of SVR with composite CVD, CHD, and MI, but not with HF, stroke or AP. Subgroup analyses detected interactions for poverty-income ratio (PIR) and BMI strata (both P for interaction = 0.005). Higher SVR may be a potential CVD risk marker, whereas associations with AP and stroke were weak or non-significant. Prospective validation is warranted. Level V-cross-sectional observational study.
Depression has been identified as a potential risk factor for motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the co-occurrence of subjective cognitive complaints and slow gait speed. However, the long-term trajectories of depressive symptoms and their associations with MCR remain unclear. A total of 3,754 participants from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) were included. Group-based trajectory modeling was employed to identify distinct depressive symptom trajectories. Multivariable logistic regression models were used to evaluate the association between these trajectories and the development of MCR. This study identified four depressive symptom trajectories: low-stable (n = 2,491, 66.4%), high-decreasing (n = 561, 14.9%), medium-increasing (n = 499, 13.3%), and high-stable (n = 203, 5.4%). After adjusting for covariates, multivariable logistic regression revealed significant associations between depressive symptom trajectories and MCR. Compared with the low-stable group, the high-decreasing group, medium-increasing group, and high-stable group all showed significantly increased odds of developing MCR. In this study cohort of older Chinese adults, long-term trajectories of depressive symptoms were associated with an elevated likelihood of MCR. These findings suggest that the longitudinal course of depressive symptoms may provide tentative insights for risk stratification and earlier identification of older adults at risk of motor-cognitive decline.
The recommended dementia diagnostic pathway comprises non-specialist assessment followed by specialist diagnosis. Given increasing resource constraints and existing inequalities in accessing specialist care, more accurate assessment in non-specialist settings may improve dementia management. This study assessed the diagnostic accuracy of blood biomarkers of Alzheimer's disease (AD) and neurodegeneration for detecting probable AD (PAD) and mild cognitive impairment (MCI) with amyloid positivity (AP), particularly when they supplement current non-specialist practice of administering Mini-Mental State Examination (MMSE). We accessed data from the Bio-Hermes study which grouped participants as cognitively normal (n=417), MCI (n=312), and PAD (n=272). Blood biomarkers of AD and neurodegeneration included: amyloid-beta 42/40; phosphorylated-tau 181 (p-tau181); p-tau217; glial fibrillary acidic protein (GFAP); and neurofilament light (NfL). Biomarkers were added individually or as panel to MMSE to predict the following diagnostic outcomes: PAD; MCI or PAD (MCI-PAD); PAD with AP measured by positron emission tomography/cerebrospinal fluid (PAD-AP); and MCI-PAD with AP (MCI-PAD-AP). Accuracy was assessed using receiver operating characteristic (ROC) curve and area under ROC curve (AUC) following logistic regression, adjusted for covariates observable in general clinical setting (e.g., alcohol, smoking, functional impairment) and apolipoprotein E ε4 carrier status. Statistically significant differences in AUC were estimated by DeLong test. Subgroup analyses were conducted by age and race/ethnicity. MMSE plus individual biomarkers or panels significantly improved accuracy to detect PAD-AP and MCI-PAD-AP versus MMSE alone: e.g., AUC for MMSE+p-tau217, adjusted for covariates, to detect MCI-PAD-AP was 0.928 versus 0.844 for MMSE alone (DeLong test for significance P<0.001); MMSE plus optimal panel comprising all five biomarkers achieved AUC of 0.939 (DeLong P<0.001 versus MMSE alone). AUC improvements from biomarker addition were smaller, sometimes not statistically significant, for PAD and MCI-PAD. Composition of optimal panel varied across subgroups: e.g., p-tau217 was included in the optimal panel for non-Hispanic White, while p-tau181 was included in the panel instead for non-White race/ethnicity. Blood biomarker supplementation of cognitive testing can improve detection of amyloid-positive MCI and dementia. This potentially supports an efficient and equitable dementia diagnostic pathway which contributes to the sustainable delivery of prospective amyloid-targeting therapies with proven safety, effectiveness and cost-effectiveness.
5-fluorouracil (5-FU) ± targeted therapy is a standard of care in frail/elderly patients with an unresectable colorectal adenocarcinoma (CRC) in first-line setting. Panitumumab plus sotorasib combination (KRAS G12C inhibitor) are promising in advanced line in KRAS G12C-mutated CRC. Here we assess the safety and efficacy of 5-FU combination with panitumumab and sotorasib as first-line treatment in frail/elderly patients with unresectable KRAS G12C-mutated CRC. In this ENGIC 01 - PRODIGE 107 - FFCD 2306 - COLOSOTO multicenter, open-label, prospective single-arm phase II trial, the main inclusion criteria are adult patients with unresectable locally advanced or metastatic KRAS G12C-mutated CRC, unfit for a doublet/triplet chemotherapy. All patients will receive 5-FU plus panitumumab and sotorasib in 2-week-cycles until progression or intolerance. The primary endpoint is 8-months progression-free survival (PFS). The secondary endpoints include median PFS, disease control rate, time to progression, overall survival, best objective response rate, duration of response, safety profile, quality of life and geriatric assessment. A 70% 8-months PFS is expected (H0 <50%), and 37 patients will need to be included. Treatment with 5-FU plus panitumumab and sotorasib could be a promising alternative to 5-FU ± targeted therapy in first-line setting in frail/elderly patients with unresectable KRAS G12C-mutated CRC.
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Hashimoto's thyroiditis (HT) is the most common autoimmune cause of hypothyroidism, often accompanied by persistent non-specific symptoms despite normalized thyroid hormone levels. Lifestyle factors, including mood, sleep, diet, and exercise, are increasingly considered in the supportive management of HT, but comprehensive characterization of lifestyle patterns in HT patients remains limited. To systematically assess the lifestyle patterns of HT patients, including psychological well-being, sleep quality, quality of life, dietary habits, and physical activity. A single-center, cross-sectional study was conducted with 226 participants (105 HT patients and 121 healthy controls). Emotional status was assessed using the GAD-7 and PHQ-9; sleep quality with the Pittsburgh Sleep Quality Index (PSQI); and health-related quality of life with the SF-36. Dietary habits and physical activity were evaluated using validated questionnaires. Serum TPOAb and TgAb levels were measured, and correlations with exercise parameters were analyzed using Spearman correlation and multivariable linear regression. All HT participants were biochemically euthyroid at enrollment; prior clinical history of hypothyroidism and LT4 treatment were extracted from medical records. HT patients exhibited higher anxiety and depression scores, poorer sleep quality, and lower quality of life compared with controls. They also reported distinct dietary patterns, including higher daily intake of meat, dairy, vegetables, and fruits and less frequent use of iodized salt. In terms of physical activity, HT patients showed more conservative exercise patterns, with greater time spent in low-intensity activity and less in moderate-intensity activity. Among HT patients, high-intensity exercise time was inversely associated with TPOAb levels after multivariable adjustment. HT patients displayed poorer psychological status, impaired sleep, and reduced quality of life, together with distinct dietary adjustments and conservative exercise patterns. In this biochemically euthyroid HT cohort, high-intensity exercise time was inversely associated with TPOAb levels. Not applicable.
The Mediterranean Diet (MD) is a dietary pattern associated with reduced chronic disease risk and increased longevity. This systematic review and meta-analysis aimed to evaluate the association between adherence to the MD and frailty and disability among older people. A comprehensive literature search was conducted in PubMed/MEDLINE, Cochrane Library, Embase, and Scopus (search date: February 28, 2024) without date restrictions. Observational and interventional studies examining the association between MD adherence (measured by any validated score) and frailty or disability, using any definition, and their complications were included. Study selection and data extraction were performed independently by pairs of reviewers using Covidence. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted, estimating pooled relative risks (RRs) per 1-point increment in MD adherence score. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated by funnel plot. Certainty of evidence was graded using the NUTRIGRADE approach. Out of 1361 screened records, 19 observational studies were included. Higher MD adherence was associated with a lower incidence (9 cohort studies, n = 94 072 participants; OR = 0.95, 95% CI: 0.93-0.97; moderate certainty of evidence) and prevalence (6 cross-sectional studies, n = 12 277participants; OR = 0.94, 95% CI: 0.90-0.98; low certainty of evidence) of frailty. The association with disability was present only for prevalence (OR = 0.98; 95% CI: 0.97-0.98). Higher adherence to the MD is associated with a reduced presence of frailty and disability in older adults. These findings support public health strategies promoting the MD as a sustainable dietary model for healthy longevity.
The association between infections and the functional independence of hospitalized older adults has not been extensively characterized. The objective of the present study was to evaluate the association between the occurrence of acute infections and loss of functional independence (LFI) in hospitalized older adults, taking into account previously identified risk factors. This French multicentre, observational, prospective cohort study (NCT02949635) included patients aged ≥75 years hospitalized in an acute geriatric unit (AGU). Information on the presence of community-acquired or nosocomial infections and the infection site was collected. The patients' functional independence (according to the Katz Index) was assessed one month before admission to hospital, on admission to the AGU, and on discharge from the AGU. A logistic regression model was used to determine the factors associated with LFI, after adjustment for morbidity and geriatric syndromes. Of the 3076 included patients (mean (standard deviation) age: 86.4 years (5.4)), 772 (23.7%) had a community-acquired infection, and 154 (5.1%) had a nosocomial infection. In a multivariate analysis, the presence of a community-acquired infection significantly increased the risk of LFI between admission and discharge (odds ratio (OR (95% confidence interval (CI): 1.34 (1.06-1.69)), after adjustment for conventional geriatric comorbidities such as cognitive impairment, malnutrition, and overall comorbidity burden. Only the need for walking assistance (OR: 1.39 (95% CI: 1.17-1.67)) and the length of hospital stay (1.01 (95% CI: 1.01-1.02)) were significantly associated with the risk of LFI. The risk of LFI was significantly higher in hospitalized older adults with an acute infection. Particular attention must be paid to maintaining these patients' functional independence as soon as an infection is identified.
As the primary living environment for disabled older adults, families play a crucial role in disease prevention and maintaining their health. However, research has found that both disabled older adults and their family members experience numerous physiological, psychological, and social adaptation problems when adjusting to the changes brought by disability, severely impacting the overall health status of the family. Therefore, guided by the ERG (Existence-Relatedness-Growth) theory, this study aims to understand the family health needs of families with disabled older adults in the community, providing a basis for improving the health level of these families and developing targeted intervention programs. From December 2024 to February 2025, this study employed purposive and snowball sampling to select 12 pairs of disabled older adults and their primary caregivers from communities under the jurisdiction of Zhengzhou City, Henan Province for semi-structured interviews. Thematic analysis was applied to organize and analyze the interview data. Deductive analysis indicated that the famliy health needs of families with disabled older adults in the community can be summarized into the following three themes: existence needs (daily living needs, economic support needs, environmental modification needs), relatedness needs (family communication needs, social resource connection needs, social participation needs), and growth needs (autonomy and dignity maintenance needs, family development needs, demand for technology-enabled solutions). The results show that the family health needs of families with disabled older adults in the community are unique and diverse. Community health workers and social workers can develop and implement effective strategies based on the different levels of family needs to promote the health level of families with disabled older adults and improve the overall quality of life of these families.
Overactive bladder (OAB) is a commonly occurring condition in older adults that has significant consequences on health and quality of life. In later life, many older adults also live with frailty, a condition characterized by vulnerability to insult and associated with a lesser probability of a full recovery. Frail older adults comprise a distinct group of older adults, often living with complex comorbid disease. There is a bidirectional relationship between frailty and OAB, though causation has not been established. β3-Adrenoreceptor agonists like mirabegron offer a pharmacological alternative over antimuscarinics, which may be associated with intolerable side effects in older patients. While mirabegron has demonstrated efficacy and tolerability in community-dwelling older adults, prospective studies on its use in frail older adults remain limited. Here, we review available evidence on use of mirabegron in older adults and frail older adults, including safety, tolerability and efficacy. Evidence suggests that mirabegron has favourable safety and side effect profiles, decreases OAB symptoms, and improves quality of life. Mirabegron remains an acceptable alternative to antimuscarinic treatment in older adults and frail older adults.
Early identification and initiation of therapy for life-threatening hemorrhage is essential to minimize patient morbidity and mortality. In primary hemostasis, platelet function is integral to reach this goal, but major hemorrhage leads to impaired platelet mechanical activation and aggregation. Current devices for measuring platelet function are cumbersome or not promptly available for clinical decision making in this setting. Within this manuscript we prospectively evaluate a novel, rapid assay utilizing measures of platelet aggregation to predict hemorrhage. In this prospective cohort study at an academic regional Level I trauma center, we included adult (> 16 years old) participants who were triaged as level I or II trauma activations. The primary exposure studied was platelet aggregation analyzed on a prototype device. The primary and secondary outcomes measured were life-threatening hemorrhage (death from hemorrhage or need for hemorrhage control procedure) and transfusion requirements of > 2 units of blood components, respectively. Standard descriptive statistics were used to characterize the cohort. Predictive outcomes were analyzed using multivariable regression to compare: (1) the platelet aggregation assay; (2) clinical parameters (systolic blood pressure, heart rate, and injury mechanism); and (3) a combined model. Of 761 patients, 482 patients met inclusion criteria for our study, 36 (7.5%) had life-threatening hemorrhage and 43 (8.9%) patients required > 2 units of blood transfusion. For life-threatening hemorrhage, platelet aggregation had an area under the curve (AUC): 0.61 (95% confidence interval [CI] 0.53-0.69); clinical parameters AUC: 0.83 (CI 0.75-0.91); and the combined model AUC: 0.85 (CI 0.79-0.92) which was not significantly improved when compared to clinical parameters alone (p = 0.32). For transfusion of > 2 units, the platelet aggregation model had AUC: 0.68 (CI 0.61-0.76); clinical parameters AUC: 0.84 (CI 0.79-0.90); and combined model AUC: 0.88 (CI 0.83-0.93), improving transfusion prediction over clinical parameters alone (p = 0.013). In a cohort of traumatically injured patients, a novel, rapid measure of platelet aggregation enhanced well-established clinical parameters to predict the need for blood transfusion but not life-threatening hemorrhage. Future work should validate the clinical utility of this technology in a larger cohort and patients with significant non-traumatic hemorrhage.
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Frailty and nutritional status are increasingly recognized as key determinants of perioperative outcomes in cranial neurosurgery. Numerous indices, including the American College of Surgeons Surgical Risk Calculator (ACS-SRC), are used for risk stratification, yet their comparative accuracy across complication domains and neurosurgical indications remains uncertain. To compare the predictive performance of five preoperative risk metrics, ACS-SRC, serum albumin, Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), and Modified Frailty Index-5 (mFI-5), for forecasting postoperative morbidity and mortality after cranial neurosurgery performed for trauma, tumor, vascular, or functional indications. Adults (>18 years) undergoing cranial neurosurgical procedures in the ACS NSQIP database (2017-2022) were analyzed. Multivariable logistic regression generated adjusted odds ratios (aORs). Discriminative performance was measured using ROC analysis and C-statistics (DeLong test). Subgroup analyses were stratified by surgical indication. Among 77,514 patients, the ACS-SRC demonstrated the highest accuracy across outcomes, with C-statistics of 0.87 (95% CI: 0.87-0.88) for mortality, 0.72 (95% CI: 0.72-0.73) for overall complications, and 0.75 (95% CI: 0.74-0.75) for major complications. Serum albumin was the next strongest predictor (mortality C-statistic 0.68, 95% CI: 0.67-0.69), outperforming or equaling frailty metrics on most endpoints. RAI exceeded mFI-5 in predictive value (mortality C-statistic 0.70, 95% CI: 0.69-0.71), while GNRI performed similarly to mFI-5 but below RAI. Higher RAI, mFI-5, and ACS-SRC scores, along with lower albumin levels, independently predicted increased 30-day mortality and complications. Subgroup analyses showed that ACS-SRC and serum albumin maintained strong performance across trauma, tumor, and vascular cohorts. ACS-SRC remains among the most accurate preoperative tools for predicting adverse outcomes after cranial neurosurgery. Serum albumin offers strong predictive capability and may serve as a practical alternative when calculator inputs are incomplete. These findings reinforce the value of structured risk stratification for surgical counseling and outcome optimization.
Understanding public beliefs about patients at memory centers may inform efforts to promote early diagnosis and guide clinical discussions of Alzheimer's disease (AD). Adults (N=3,527) read a vignette describing a fictional person at a memory center and rated the person's condition as a mental illness, part of typical aging, and psychological or biological origins. Vignettes varied by AD biomarker result, symptom stage, and treatment availability. Participants most strongly believed that the condition was part of typical aging and biological in origin, though beliefs varied across subgroups. Black and Asian participants reported stronger beliefs than White participants that the condition was a mental illness (β=0.39, P<0.001) and psychological (β=0.46, P<0.001). Men reported stronger beliefs that the condition was a mental illness (β=0.19, P<0.001), psychological (β=0.14, P<0.001), and part of typical aging (β=-0.08, P=0.04). Biomarker positivity heightened biological and lowered psychological attributions (all P<0.05). The findings offer specific insights to guide intervention.
Adolescence is a critical developmental period marked by a heightened vulnerability to loneliness, a subjective distress linked to anxiety and depression. Evidence for interventions is particularly limited in low- and middle-income countries. This study evaluated the effect of a brief, group-based social skills training program on loneliness, depression, and anxiety among adolescent girls in Tehran, Iran. A randomized controlled trial was conducted with 100 girls aged 12-14, randomly allocated to an intervention group (n = 50) or a no-intervention control group (n = 50). The intervention consisted of three 4-hour recreational-educational sessions delivered over consecutive days. The primary outcome was loneliness, measured using the UCLA Loneliness Scale. Secondary outcomes were depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory), assessed at baseline and 8-week follow-up. Data were analyzed using analysis of covariance (ANCOVA) adjusting for baseline scores, with an intention-to-treat approach and no attrition. While both groups demonstrated significant within-group reductions in loneliness, anxiety, and depression over time (all p < 0.01), ANCOVA revealed no statistically significant between-group differences at post-intervention for loneliness (F = 3.255, p = 0.074, partial η2 = 0.032), anxiety (F = 0.470, p = 0.495, partial η2 = 0.005), or depression (F = 0.723, p = 0.397, partial η2 = 0.007). The brief social skills training did not demonstrate statistically significant superiority over the control condition in reducing loneliness, anxiety, or depression. Future interventions may require a longer duration or different components to achieve a significant comparative benefit.
Acetabular fractures are uncommon, but serious injuries. Demographic changes may have a significant impact on planning healthcare structures to improve treatment outcomes. Aim of this nationwide, registry-based retrospective controlled study was to identify incidence trends, demographic characteristics, and care structures of patients with acetabular fractures in Germany. We analyzed inpatient data from the Institute for the Hospital Remuneration System (InEK). Based on 52 095 patients with primary diagnosis of an acetabular fracture between 2019 and 2024, we calculated incidence rates for different age-groups and put a spotlight on geriatric acetabular fractures (> 65 years of age). Incidence rates in patients under 65 years remained stable, whereas patients over 65 years showed a significant age-dependent increase with an exponential rise in men aged 80 + with the highest incidence being 122.4/100 000 inhabitants annually. We recorded high levels of co-morbidity and nursing care dependency for elderly patients after acetabular fracture. Although 43% of patients were treated in hospitals > 500 beds, acetabular fractures were managed across all hospital sizes. There is a rapidly increasing incidence of geriatric acetabular fractures, predominantly driven by elderly male patients over 80 years. Patients over 65 years are associated with high rates of co-morbidities and nursing care levels.
Postoperative organ dysfunction is a leading cause of death and disability following hip fracture surgery in older patients. Intraoperative hypotension is a major modifiable risk factor for this complication, yet the optimal management strategy to prevent it remains controversial. We hypothesize that an individualized blood pressure management strategy is superior to standard management in reducing postoperative organ dysfunction. This single-center, randomized, controlled trial will enroll 180 patients aged 65-85 years with hip fractures under general anesthesia. Eligible patients will be randomly allocated in a 1:1 ratio to the individualized management group (targeting systolic blood pressure within ± 10% of baseline) or the standard management group (reactive management, where intervention is initiated only if systolic blood pressure < 90 mmHg or decrease of > 30% from baseline). A universal mean arterial pressure target of ≥ 65 mmHg will be maintained for all patients. The allocated hemodynamic management strategy will be maintained throughout surgery and during the post-anesthesia care unit stay. The primary outcome is a composite of dysfunction in at least one organ system (respiratory, cardiovascular, renal, and neurological) within 7 days after surgery. Secondary outcomes include the components of the primary outcome, intraoperative variables (including hemodynamic management data, fluid balance, blood loss, and serum lactate levels), intensive care unit and hospital stay, and all-cause mortality within 30 days after surgery. This randomized controlled trial aims to determine whether individualized blood pressure management reduces postoperative organ dysfunction more effectively than standard management in older hip fracture surgery patients. If proven effective, this proactive approach may represent a significant advance in clinical practice, moving from reactive hypotension correction to preventive stabilization, potentially reducing major complications, shortening hospital stays, and improving functional recovery. The results will provide important evidence to guide hemodynamic management during general anesthesia in this vulnerable population, contributing to standardized, evidence-based protocols for enhancing perioperative outcomes. Trial registration: Chinese Clinical Trial Registry, ChiCTR2400093838. Registered on 12 December 2024. This manuscript presents the study protocol; participant recruitment is ongoing and results will be reported upon trial completion.
Although research on palliative care in hematological malignancies has increased, research examining quality of death (QOD) and quality of care (QOC) in this population remains limited. This study compared QOD and QOC between patients with hematological malignancies and those with solid tumors. The authors conducted a secondary analysis of a nationwide mortality follow-up survey of bereaved family members in Japan (2017-2018). The study included 3575 decedents with hematological malignancies and 50,592 with solid tumors. Propensity score matching was performed to adjust for demographic and clinical characteristics. QOD and QOC were assessed using the Good Death Inventory (GDI) and the Care Evaluation Scale 2.0 (CES). Bivariate analyses compared the matched groups. Overall, QOD and QOC were comparable between groups. However, among the GDI subdomains, patients with hematological malignancies had slightly lower scores for "good relationships with family" (mean difference, 0.2; 95% confidence interval [CI], 0.03-0.3) and "preparation for death" (mean difference, 0.2; 95% CI, 0.04-0.3). In addition, patients with hematological malignancies were less likely to die in palliative care units than those with solid tumors (mean difference, 3.9%; 95% CI, 0.4%-7.4%). Although overall quality measures were similar, specific QOD domains related to family relationships and preparation for death were slightly lower among patients with hematological malignancies. These findings may reflect limited opportunities for end-of-life discussions due to the unpredictable and rapidly progressive course of hematological malignancies. Enhancing communication about prognosis and goals of care and early integration of palliative care may improve end-of-life experiences.